Deadbeat Illinois: Bills backlog pinches ambulance services

When an ambulance is dispatched in Illinois to help the victim of a car crash, shooting or heart attack, the paramedics who arrive don’t ask whether that person has a certain kind of health insurance or no coverage at all.

Inside: By the numbers

By Dean Olsen

Journal Standard

By Dean Olsen

Posted Jan. 21, 2013 at 12:01 AM
Updated Jan 21, 2013 at 8:06 PM

By Dean Olsen

Posted Jan. 21, 2013 at 12:01 AM
Updated Jan 21, 2013 at 8:06 PM

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When an ambulance is dispatched in Illinois to help the victim of a car crash, shooting or heart attack, the paramedics who arrive don’t ask whether that person has a certain kind of health insurance or no coverage at all.

Ambulance services can’t discriminate when it comes to relieving patients’ suffering. But the state’s backlog of bills is inflicting financial pain on ambulance providers if those patients are covered by Medicaid or the group health-insurance program for state employees, retirees and dependents.

“Nobody seems to care,” said Andrew Thornton, the Illinois State Ambulance Association’s chairman for governmental affairs.

Delays of six months to a year for Medicaid payments, and delays of more than a year for state employee insurance, have prompted ambulance services to borrow money to make payroll. The delays, on top of inadequate Medicaid payments, also have depressed salaries for ambulance crew members and made it harder to replace aging equipment, emergency medical service officials say.

There’s no hard data, just anecdotal reports that the cash-flow problems have resulted in fewer ambulances on the road and longer response times, Thornton said. Delays in medical attention can result in death and in long-term health consequences for those who survive.

“There is a human cost involved, but it’s hard to quantify,” said Thornton, a paramedic who lives in Springfield and directs the nonprofit Fulton County Emergency Medical Association.

The 400 to 500 ambulance services in Illinois operate under a variety of structures. Some are part of city or village government, some are nonprofits that contract with local governments, some are private companies that may be dispatched to 911 emergency calls by government-operated call centers.

But when they bill for services, many are suffering because of payment delays.

Delays in state payments began to get worse in 2009 and 2010 and are closely related to the economic downturn, Thornton said. The impact was magnified in July, when a 2.7 percent Medicaid rate cut imposed by Gov. Pat Quinn and the General Assembly took effect for most services provided by ambulance crews.

That cut, on top of a 6 percent Medicaid rate cut in 2002, rolled the rates back to levels paid in the 1990s.

An ambulance trip and aggressive medical services provided by paramedics might generate a $700 to $900 payment from private insurance but less than $300 from Medicaid, Berg said.

There’s no end in sight to the payment delays.

The Legislature approved $550 million in spending for state employee health coverage this fiscal year, but the bills for that coverage are expected to total $2.65 billion. Underfunding of the employee health liability means bills get pushed into the next fiscal year before they can be paid.

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The state paid $87 million in interest payments last year to medical providers owed money by the state insurance program, said Scott Adams, director of research and employee benefits for Council 31 of the American Federation of State, County and Municipal Employees.

Illinois owes about $20 million to medical transportation providers, with most of the money owed to ambulance providers, said Kelly Jakubek, spokeswoman for the Illinois Department of Healthcare and Family Services.

The state owes about $9 billion to vendors of all types.

Until lawmakers and the governor can resolve funding issues involving state employee pensions, “there will be many funding issues that will be very challenging for the state to deal with” Jakubek said. “This is across the board in terms of health care, education, public safety and many other vital state programs.”

Rep. Donald Moffitt, R-Galesburg, was part of a bipartisan House task force that held hearings throughout the state and produced a report in November on emergency medical service funding. EMS service is “a very basic funding role of government and should be considered an essential service,” he said, regardless of whether the provider is for-profit or not-for-profit.